Pilocarpine/Tolterodine

Drugs which prevent acetylcholine mediated involuntary detrusor contractions are the mainstay of overactive bladder(OAB) treatment but there are now several alternative therapeutic options available.

Current and future drug therapies for OAB are highlighted. These include novel antimuscarinic molecules (imidafenacin and tarafenacin); novel combination therapies with β3-adrenoceptor agonists or muscarinic agonists (tolenix) and a novel vaginal delivery method for oxybutynin. β3-adrenoceptor agonists(β3-AR) have been shown to be efficiacious in the management of OAB. The evidence supporting the first licensed β3-AR agonist, mirabegron, is assessed, as well as other putative β3-AR agonists in development such as solabegron, ritobegron, aryloxypropanolamine, TRK-380, and CL 316,243. The role of vaginal oestrogen is highlighted followed by a detailed analysis of botulinum-A toxin.

Anticholinergics were the first OAB drug therapy on the market and have the largest dataset available. Despite obvious limitations, these are still first line medical therapy. There are a number of new OAB therapies under investigation and we await their contribution to the management armamentarium. Other novel drugs have been licenced and these are now vying for pole position in the treatment algorithm. One must exercise caution however until the long term effects of any new medicines are known.